Biomarkers Score for Patients with Mitral Stenosis: A useful conjunction with Wilkins’s Score for Early Intervention

Abstract

Objective: We proposed a novel new insight independent score of Mitral Stenosis (MS) based
on elevated biomarkers.
Subjects and Methods: One hundred sixty-eight patients with MS candidate for Percutanous
balloon valvuloplasty (PBMV) were included in the study. Brain Natriurectic Peptide (BNP),
Tenascin-C (TN-C), copeptin and high-sensitive C-reactive protein (hs-CRP) were measured
before PBMV. The cut-off value of each biomarker for prediction of systolic pulmonary artery
pressure >50 mm Hg was calculated. Two points were given to a value ≥cut-off value and one
point if less. Summation of points gave the biomarkers score.
Results: A biomarker score cut-off value ≥5.2 had a sensitivity of 83.6%, a specificity of 82.9%
(AUC=0.85), in predicting cardiac events after successful PBMV. The Wilkins’s score of ≥6.5
had a sensitivity of 73.5%, a specificity of 79.2% (AUC=0.80). The conjunction of Wilkins’s
score with biomarker score have higher predicting power (AUC=97%). The correlation co-efficient
of biomarker score was (r=0.755), greater than that of the Wilkin’s score (r=0.613). The
combined biomarkers and Wilkins’s score showed the strongest correlation with cardiac events
(r=0.911). In multiple regression analysis, the regression co-efficient of biomarker score versus
Wilkin’s score was (0.595 versus 0.364), and the combined scores had the strongest powerful
independent predictor of cardiac events (r=0.825).
Conclusions: In patients with MS especially asymptomatic patients, biomarker risk score that
included BNP, tenacin-c, copeptin and hs-CRP and, had a good correlation with clinical outcomes
after successful PBMV, and the conjunction of the biomarkers score and Wilkin’s score
provided higher prognostic value.